When shopping for a child’s princess or fancy dress up costume, there’s a good chance that along with a dress and tiara, there will be a small pair of plastic “high heel” slippers. Of course, the shoes aren’t really that high – after all these will be worn by a young child. However, even that small increase in heel height is enough to throw off their walking gait.
Fast-forward to when those feet have grown a bit and it’s time to go shoe shopping. Whether it’s casual boots, prom shoes, or sparkly sandals, the range in heel height gets taller and taller. So, does the heel height of shoes have a significant impact on balance and coordination of adults too? It does! In the evening gown competition of the Miss USA competition, a contestant fell while walking in high heels. This happened not once, but twice, in both 2007 and 2008! Surely these young ladies have plenty experience with high heels. Yet, the heels were enough to affect their balance and cause a fall.
Some have wondered if being “fashionable” by wearing high heels sets the stage for musculoskeletal issues in the future? According to Gerard W. Clum, D.C., past president of Life Chiropractic College West, “Wearing them affects the entire body, particularly the knee, hip and spine…The abnormal weight bearing and stressful posture induced by high heels can strain both the lower back and the neck – not to mention the feet, ankles and knees.”
How can high-heels cause problems with posture, balance, back or neck pain?
A 2016 study published in the European Spine Journal set out to investigate the impact high heels have on the body and why they are often associated with pain in the neck, back and knees.
They conducted radiographic imaging of female subjects with, and without, high heels. They measured the alignment between the head, spine and pelvis in both positions and analyzed the similarities and/or differences between the two positions. They found that when wearing high heels, the subjects tended to experience an increase in the femoral obliquity angle as well as flexion of the knee and ankle.
The femoral obliquity angle is sometimes called the “carrying angle”. It has been found to be an important predictor of disability and quality of life after spinal surgery for adult spinal deformity patients. It has also been shown to be an early indicator of possible spinal sagittal malalignment.
Those subjects who did not have as significant an increase in knee flexion, tended to experience an increase in the curve of the neck (5.8 vs 1.8). Researchers determined wearing high heels caused a shift in the body’s center of gravity and all these changes were a result of the body attempting to adapt to that change.
Are postural effects of high heels limited to adults?
A group of researchers reviewed and analyzed 20 research articles published between 1980 and 2011 that reported on posture and high-heeled shoe usage in adolescents. They concluded from the data that the frequent use of high-heeled shoes did more than alter the body’s center of gravity and body balance. The change in balance then led to deviations in the alignment of body segments. Additionally, these changes had a “negative impact on motor development of adolescents”. They concluded that adolescents wearing high-heeled shoes contributed to the development of posture disorders including: “forward head posture, lumbar hyperlordosis, pelvic anteversion, and knee valgus.” They advocate that maintaining proper posture is vital to healthy physiological growth and development of the musculoskeletal system.
Will the postural effects of high heels become worse with age?
The potential damage to the musculoskeletal system due to wearing high-heel shoes does not stop after adolescence, and in fact may increase. A study was conducted which investigated the EMG activity of the core muscles and movement of the pelvis while walking of both young women (20-25 years) and middle-aged women (45-55). Measurements were repeated while subjects walked at a natural pace on a flat surface without shoes, in low-heeled shoes (4cm) and high-heeled shoes (10 cm). The measurements were then compared and analyzed.
Researchers found that among younger women, there was a significant difference in the EMG readings of the lower back spinal muscles with activity increasing as the heel height increased. The activity was even higher among the older women. Additionally, the younger women demonstrated an increase in pelvic range of motion with the higher-heel height that was not present in the older women.
Researchers concluded that the increased activity associated with wearing high-heeled shoes “could exacerbate muscle overuse and lead to low back problems.” Further they suggest that the lack of increase in range of motion in the older women could signify that the tissues in that region become more rigid with age and that this could contribute to the harmful effects of high-heeled shoes being more significant as individuals age.
Should we avoid high heels altogether? Not necessarily!
Experts say the height and width of the heels are what make the most difference in the degree of changes to posture and balance. Lower height produces less pressure on the forefoot, or ball of the foot. As the heels increase in height, the pressure also increases.
For example, studies have shown that when wearing a 2-inch heel the weight pressure on the ball of the foot is 57% versus 22% when wearing 1-inch heels. So, choose lower height when possible.
Also, by choosing a variety of heel styles and heights and alternating between them, you can express your fashion sense while giving your feet a break. If you can, limit the usage of heels greater than 2 inches to 2 hours per day, but you don’t have to use flats the rest of the time. Doctors of chiropractic suggest keeping your heels to 2 inches or less, for most of the time, as a good compromise. And don’t forget a good arch support! Taking a moment for a good stretch of your leg muscles before and after wearing high heels can also help reduce their negative effects and help keep you ready for the dance floor all night.
If you wear heels often or have any other questions about your posture, schedule an appointment with your chiropractor. Even if you do not have pain now, learning about simple stretches and/or exercises that you can do to combat negative consequences of high heels can help you stay pain free. Remember, feeling good will go a lot further than a pair of shoes when it comes looking good!
“High Heels: Friend or Foe?” https://www.tnchiro.com/articles/high-heels-friend-or-foe/ Posted: May 1, 2017, accessed 5/12/22.
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Mika A, Oleksy L, Mika P, Marchewka A, Clark BC. The effect of walking in high- and low-heeled shoes on erector spinae activity and pelvis kinematics during gait. Am J Phys Med Rehabil. 2012 May;91(5):425-34. doi: 10.1097/PHM.0b013e3182465e57. PMID: 22311060. accessed 5/12/22.
Weitkunat T, Buck FM, Jentzsch T, Simmen HP, Werner CM, Osterhoff G. Influence of high-heeled shoes on the sagittal balance of the spine and the whole body. Eur Spine J. 2016 Nov;25(11):3658-3665. doi: 10.1007/s00586-016-4621-2. Epub 2016 May 20. PMID: 27206516. accessed 5/12/22.
Perna A, Proietti L, Smakaj A, Velluto C, Meluzio MC, Rovere G, Florio D, Zirio G, Tamburrelli FC. The role of femoral obliquity angle and T1 pelvic angle in predicting quality of life after spinal surgery in adult spinal deformities. BMC Musculoskelet Disord. 2021 Nov 30;22(Suppl 2):999. doi: 10.1186/s12891-021-04823-3. PMID: 34847906; PMCID: PMC8630841. accessed 5/12/22.